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HomeMy WebLinkAboutBuilding Permit # 4/5/2016Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page LOCATION S-(0 14 6-1-1 PROPERTY OWNER %. C6- MAP PARCEL: if5q N C Prin N i3.Hi lie 141510- k (( LL Print 100 Year Structure ZONING DISTRICT: Historic District Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential CI New Building 111 Addition rli Iteration CI One family 0 Two or more family No. of units: 0 Industrial X Commercial -.,. 0 Repair, replacement D Demolition 0 Assessory Bldg CI Others: -- 0 Other L %e.i, 4, ,,- ' Floodplain , Wetlands' ,f'Z'if T ' -41t '. Watershed-.. District iii ,Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 0 Li -r-2 t5j f n— (fl- 2d-ea so 0 it (TT Identification - Please Type or Print Clearly OWNER: Name: rD 0 L5-i 61 cs-YL-c, Phone: Address: ‘). CP-C 0 I -7- r9 0 d Trr 0 L- Lc 044— W L. c Contractor Name:1-K e4 N-rnul-cin tvC LL (1-- Phone: t t -7 z- - Email: k-i K44--) C‘) NJ rre`144- c co elA Address: Supervisor's Construction License: e—s (7) 6 ? Home Improvement Improvement License: Exp. Date: 4--9 619 • , ARCHITECT/ENGINEER /, .1-)rsoi t9Thone: 1q q 7 kt; Address:2-A ti(ctiARA-v---' Reg. No. 161) FEE SCHEDULE: BULDING PERMIT: $12.00 PER b1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ b 0 1 7 --- FEE: $ A"- kt%53 Check No.: <9451 Receipt No.: 21)(e NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted Plans Waived _ Certified Plot Plan _ Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer — Tanning/Massage/Body Art Swimming Pools ❑ Well _ Tobacco Sales Food Packaging/Sales ❑ Private (septic tank, etc. _ Permanent Dumpster on Site _ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on COMMENTS Signature HEALTH Reviewed on COMMENTS Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature & Date DPW Town Engineer: Signature: Driveway Permit Located 384 Osgood Street FIRE DEPARTME T , -Temp. Dumpster on site yes Located of 124 Main Sfreet' Fire Department signature/date EOM a) Cl) 0 c" 0 CD 0_ co ®-a • Fnco co O O ® cD O tu St CD O COC▪ D 0 • O y▪ . CQ. C I E. • Z CD 0 n �.+. O 3 naap 01 padpi �101�3dSNl JNlalln8 NOIl3fl J1SNOO SS31Nf1 55 cn 0 V) VIOLATION of the Zoning or Building Regulations Voids this Permit. y • o n3a.2 -- ��ngFD-• o o W nsm c cu m CO Q- rt n O -0 CD M o O CQ O O ,..*, O - Z to o )> CD Cn _. p1 O O. • N E Cn w 2, ✓ N a,•a CD O CO 3 O 0 st� Co CD c� w m N .t 'a 0 • Cn C7 O • CD CD la O. O O _rt CD O O sa }Dale o; uolsslwjed seq • 1dHl S3IdI1N3O SIHI OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 15-0718 PROJECT TITLE: West Mill - Suite 10 - New England League of Middle Schools PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant demising and tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, )0�a�,�1 i J /��� �Z REGISTRATION NO. 9 S BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT e ARCHITECTURAL STRUCTURAL MECHANICAL FIRE PROTECTION ELECTRICAL ® OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 I SHALL SUBMIT WEEKLY , A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. SUBSCRIBED AND S. J;tM TO BEFOR NOTARY PUBLI ME THIS )U� DAY OF MY COMMISSION EX RE 20 ) CHERYL L. BURKINSHAW Notary Public Commonwealth of Massachusetts y ommission Expires March 7, 2019 JK Contracting LLC 31 Richmond Street Weymouth, MA 02188 617-592-6775 (Kieran) 781-254-2862 (Judy) Bill To: David Streinbergh NELMS, Suite 101, 50 High St N. Andover, MA 01845 Description . Hours/Qty. Proposal Proposal Date: 4/4/2016 Proposal #: 203-7 Project: Rate Total Permit, C of 0 490.00 490.00 Demo 500.00 500.00 Wall Framing, includes building cubicles 2,000.00 2,000.00 Doors & Trim 750.00 750,00 Heating & Cooling,[Estimate] 9,150.00 9,150.00 Electrical & Lighting 3,500.00 3,500.00 Tele/Data 1,750.00 1,750.00 Interior Walls, Board, Tape, sand 5,000.00 5,000.00 Insulation 500.00 500.00 Millwork & Trim, maple cap 750.00 750,00 Floor Coverings 4,300.00 4,300.00 Painting 3,500.00 3,500.00 Cleanup & Restoration 200.00 200.00 General Conditions 500.00 500.00 Supervision 3,289.00 3,289.00 Insurance,1% 328.90 328.90 -- CHANGE ORDER ----- April 5, 2016 > Removed 1 29 Supervision. (-$2,833.00) > Removed 1 30 - Insurance. (-$283.30) > Increased price of 15;HVAC from $5,000.00 to $9,150.00. (+$4,150.00) > Added 1 29 Supervision. (+$3,289.00) Added 1 30 - Insurance. (+$328.90) Total change to estimate +$4,651.60 ..........__. Estimate for your review and approval . Total $36,507.90 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street .Boston, MA 02111 _ www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): I( Co 1 r c-rri Address: _cu icy'® 10 1-a- 6= k r-iv 0 0 (1,r-- City/State/Zip: ► D 0 tl,lw 01 Phone #: ' 7 T q .Z ®� Are you an employer? Check the appropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and'have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 'am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. t These sub -contractors have workers' comp. insurance. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. n ty L 1 'I'�f vvL t vt► G2i f" ' 6` �i,'' L ((Li C . Insurance Company Name:. � S( Policy # or Self -ins. Lie. #: (ei 7 Z- rre4 Expiration Date: 2 6 , d ( (- Job Site Address: 5 0 141 6'14 ,City/State/Zip: 1109 0 t 4' Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains andpenalties of pedury that the information provided above is true and correct. Signature: ,� Date: E44 6 . Phone #: k ! Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: INSR LTR AW THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER DeSanctis Insurance Agcy, Inc. 100 Unicorn Park Drive Woburn, MA 01801 INSURED CERTIFICATE OF LIABILITY INSURANCE JK Contracting, LLC. 4 High Street Suite 108 North Andover, MA 01845 CONTACT NAME: JKCON-1 OP ID: HS DATE (MMIDDIYYYY) 02/17/2016 PHONE (AM, No, Extl: E-MAIL ADDRESS: FAX (A/C, No): INSURER(S) AFFORDING COVERAGE INSURER A : Star Insurance Company INSURER B : Selective Insurance Company INSURER C : NAIC # 012245 19259 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP (MMIDDIYYYY) (MMIDDIYYYY) TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT ADDL INSD SUBR WVD POLICY NUMBER S2205113 02/10/2016 02/10/2017 REVISION NUMBER: LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGO AU OTHER: OMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ 100,000 $ 10,000 $ 1,000,000 $ 3,000,000 $ 3,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE DED I I RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N NIA WC0853742 MA 02/17/2016 02/17/2017 EACH OCCURRENCE AGGREGATE $ X I STA STATUTE I ER H E.L. EACH ACCIDENT E.L. DISEASE- EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 100,000 $ 100,000 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of coverage. CERTIFICATE HOLDER TO WHOM IT MAY CONCERN TO WHOM CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-066334 Construction Supervisor • KIERAN-T WHELAN 31 RICHMOND STRE WEYMOUTH MA 021$ Commissioner Expiration: 09/26/2017